M. McCabe1, R. W. Randle1, H. Chen1,2, C. J. Balentine1 1University Of Wisconsin,Department Of Surgery,Madison, WI, USA 2University Of Alabama,Department Of Surgery,Birmingham, Alabama, USA
Introduction: Improving the quality of care as patients transition from the hospital to home has been highlighted by the Institute of Medicine and the Centers for Medicare and Medicaid Services as a priority area for enhancing patient-centered care. The quality of care transitions has been assessed for complex inpatient medical and surgical patients but has never been evaluated for outpatient surgery. The purpose of this study was to use a validated transitions instrument to determine how well patients were being prepared for outpatient surgery at an academic hospital. We hypothesized that our extensive preoperative education and patient support services would result in excellent preparation for surgery and would be reflected by high scores on the instrument.
Methods: We administered the Care Transitions Measure (CTM), a validated assessment of care transition quality, to patients undergoing outpatient endocrine surgery. The survey measures patient comprehension of medications, treatment and discharge plans. Participants were surveyed at three time points: the pre-operative clinic visit, after surgery on the day of discharge, and at the post-operative clinic visit. The primary endpoint was CTM score at each time point. Secondary outcomes included postoperative complications.
Results: We approached 110 patients and 92 (84%) agreed to participate. Mean CTM scores for complex medical and surgical inpatients typically range from 65-70 on a 100 point scale, but our patients had considerably higher scores at all time points (Figure). After the initial clinic visit, mean CTM was 89 ± 2. After surgery, CTM scores remained high with a mean of 92 ± 1.7 on the day of surgery and 90 ± 2 at the postoperative visit, though none of the differences was statistically significant. These scores indicated that our patients had excellent comprehension of treatment plans, understood their medications, and felt that followup plans were adequately explained throughout their surgical experience. There was no significant difference in CTM scores between patients with and without postoperative complications.
Conclusions: Overall CTM scores in our population were extremely high following outpatient endocrine surgery. There are many mechanisms used at our institution to enhance patient understanding and care coordination including dedicated nursing staff, carefully constructed written educational material, easy access to surgeons by phone/e-mail and reinforcement of education in the clinic. Further work will explore which of these mechanisms is most responsible for our high quality care transitions.
